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Massachusetts Senate Bill S835

Massachusetts 2025-2026 Regular Session

Massachusetts Senate Bill S835 Compare Versions

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22 SENATE DOCKET, NO. 1151 FILED ON: 1/15/2025
33 SENATE . . . . . . . . . . . . . . No. 835
44 The Commonwealth of Massachusetts
55 _________________
66 PRESENTED BY:
77 John C. Velis
88 _________________
99 To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
1010 Court assembled:
1111 The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
1212 An Act to further define medical necessity determinations.
1313 _______________
1414 PETITION OF:
1515 NAME:DISTRICT/ADDRESS :John C. VelisHampden and Hampshire 1 of 14
1616 SENATE DOCKET, NO. 1151 FILED ON: 1/15/2025
1717 SENATE . . . . . . . . . . . . . . No. 835
1818 By Mr. Velis, a petition (accompanied by bill, Senate, No. 835) of John C. Velis relative to
1919 health plan coverage for medically necessary mental health crisis stabilization services.
2020 Financial Services.
2121 [SIMILAR MATTER FILED IN PREVIOUS SESSION
2222 SEE HOUSE, NO. 1068 OF 2023-2024.]
2323 The Commonwealth of Massachusetts
2424 _______________
2525 In the One Hundred and Ninety-Fourth General Court
2626 (2025-2026)
2727 _______________
2828 An Act to further define medical necessity determinations.
2929 Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
3030 of the same, as follows:
3131 1 SECTION 1. Chapter 32A of the General Laws is hereby amended by inserting after
3232 2section 17R the following section:-
3333 3 Section 17S. For the purposes of this section the following terms shall, unless the context
3434 4clearly requires otherwise, have the following meanings:
3535 5 “Mental health acute treatment”, 24-hour medically supervised mental health services
3636 6provided in an inpatient facility, licensed by the department of mental health, that provides
3737 7psychiatric evaluation, management, treatment and discharge planning in a structured treatment
3838 8milieu. 2 of 14
3939 9 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
4040 10diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
4141 11provided as an alternative to mental health acute treatment or following mental health acute
4242 12treatment, which may include intensive crisis stabilization counseling, outreach to families and
4343 13significant others and aftercare planning.
4444 14 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
4545 15diversionary or step-down services for children and adolescents, as defined by the department of
4646 16early education and care, usually provided as an alternative to mental health acute treatment.
4747 17 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
4848 18managed mental health diversionary or step-down services for children and adolescents, as
4949 19defined by the department of early education and care, usually provided as an alternative to
5050 20mental health acute treatment.
5151 21 The commission shall provide to any active or retired employee of the commonwealth
5252 22who is insured under the group insurance commission coverage for medically necessary mental
5353 23health acute treatment and shall not require a preauthorization prior to obtaining treatment.
5454 24Medical necessity shall be determined by the treating clinician in consultation with the patient
5555 25and noted in the patient’s medical record.
5656 26 The commission shall provide to any active or retired employee of the commonwealth
5757 27who is insured under the group insurance commission coverage for medically necessary mental
5858 28health crisis stabilization services for up to 14 days and shall not require preauthorization prior to
5959 29obtaining such services; provided, that the facility shall provide the carrier both notification of
6060 30admission and the initial treatment plan within 48 hours of admission; provided further, that 3 of 14
6161 31utilization review procedures may be initiated on day 7. Medical necessity shall be determined
6262 32by the treating clinician in consultation with the patient and noted in the patient’s medical record.
6363 33 The commission shall provide to any active or retired employee of the commonwealth
6464 34who is insured under the group insurance commission coverage for medically necessary
6565 35community based acute treatment services for up to 21 days; provided, that the facility shall
6666 36provide the carrier both notification of admission and the initial treatment plan within 48 hours
6767 37of admission; provided further, that utilization review procedures may be initiated on day 10.
6868 38Medical necessity shall be determined by the treating clinician in consultation with the patient
6969 39and noted in the patient’s medical record.
7070 40 The commission shall provide to any active or retired employee of the commonwealth
7171 41who is insured under the group insurance commission coverage for medically necessary
7272 42intensive community based acute treatment services for up to 14 days; provided, that the facility
7373 43shall provide the carrier both notification of admission and the initial treatment plan within 48
7474 44hours of admission; provided further, that utilization review procedures may be initiated on day
7575 457. Medical necessity shall be determined by the treating clinician in consultation with the patient
7676 46and noted in the patient’s medical record.
7777 47 SECTION 2. Chapter 118E of the General Laws is hereby amended by inserting after
7878 48section 10N the following section:-
7979 49 Section 10O. For the purposes of this section the following terms shall, unless the context
8080 50clearly requires otherwise, have the following meanings:
8181 51 “Mental health acute treatment”, 24-hour medically supervised mental health services
8282 52provided in an inpatient facility, licensed by the department of mental health, that provides 4 of 14
8383 53psychiatric evaluation, management, treatment and discharge planning in a structured treatment
8484 54milieu.
8585 55 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
8686 56diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
8787 57provided as an alternative to mental health acute treatment or following mental health acute
8888 58treatment, which may include intensive crisis stabilization counseling, outreach to families and
8989 59significant others and aftercare planning.
9090 60 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
9191 61diversionary or step-down services for children and adolescents, as defined by the department of
9292 62early education and care, usually provided as an alternative to mental health acute treatment.
9393 63 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
9494 64managed mental health diversionary or step-down services for children and adolescents, as
9595 65defined by the department of early education and care, usually provided as an alternative to
9696 66mental health acute treatment.
9797 67 The division and its contracted health insurers, health plans, health maintenance
9898 68organizations, behavioral health management firms and third party administrators under contract
9999 69to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
100100 70medically necessary mental health acute treatment and shall not require a preauthorization prior
101101 71to obtaining treatment. Medical necessity shall be determined by the treating clinician in
102102 72consultation with the patient and noted in the patient’s medical record.
103103 73 The division and its contracted health insurers, health plans, health maintenance
104104 74organizations, behavioral health management firms and third party administrators under contract 5 of 14
105105 75to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
106106 76medically necessary mental health crisis stabilization services for up to 14 days and shall not
107107 77require preauthorization prior to obtaining such services; provided, that the facility shall provide
108108 78the carrier both notification of admission and the initial treatment plan within 48 hours of
109109 79admission; provided further, that utilization review procedures may be initiated on day 7.
110110 80Medical necessity shall be determined by the treating clinician in consultation with the patient
111111 81and noted in the patient’s medical record.
112112 82 The division and its contracted health insurers, health plans, health maintenance
113113 83organizations, behavioral health management firms and third party administrators under contract
114114 84to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
115115 85medically necessary community based acute treatment services for up to 21 days; provided, that
116116 86the facility shall provide the carrier both notification of admission and the initial treatment plan
117117 87within 48 hours of admission; provided further, that utilization review procedures may be
118118 88initiated on day 10. Medical necessity shall be determined by the treating clinician in
119119 89consultation with the patient and noted in the patient’s medical record.
120120 90 The division and its contracted health insurers, health plans, health maintenance
121121 91organizations, behavioral health management firms and third party administrators under contract
122122 92to a Medicaid managed care organization or primary care clinician plan shall cover the cost of
123123 93medically necessary intensive community based acute treatment services for up to 14 days;
124124 94provided, that the facility shall provide the carrier both notification of admission and the initial
125125 95treatment plan within 48 hours of admission; provided further, that utilization review procedures
126126 96may be initiated on day 7. Medical necessity shall be determined by the treating clinician in
127127 97consultation with the patient and noted in the patient’s medical record. 6 of 14
128128 98 SECTION 3. Chapter 175 of the General Laws is hereby amended by inserting after
129129 99section 47NN the following section:-
130130 100 Section 47OO. For the purposes of this section the following terms shall, unless the
131131 101context clearly requires otherwise, have the following meanings:
132132 102 “Mental health acute treatment”, 24-hour medically supervised mental health services
133133 103provided in an inpatient facility, licensed by the department of mental health, that provides
134134 104psychiatric evaluation, management, treatment and discharge planning in a structured treatment
135135 105milieu.
136136 106 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
137137 107diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
138138 108provided as an alternative to mental health acute treatment or following mental health acute
139139 109treatment, which may include intensive crisis stabilization counseling, outreach to families and
140140 110significant others and aftercare planning.
141141 111 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
142142 112diversionary or step-down services for children and adolescents, as defined by the department of
143143 113early education and care, usually provided as an alternative to mental health acute treatment.
144144 114 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
145145 115managed mental health diversionary or step-down services for children and adolescents, as
146146 116defined by the department of early education and care, usually provided as an alternative to
147147 117mental health acute treatment. 7 of 14
148148 118 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
149149 119renewed within the commonwealth, which is considered creditable coverage under section 1 of
150150 120chapter 111M, shall provide coverage for medically necessary mental health acute treatment and
151151 121shall not require a preauthorization prior to obtaining treatment. Medical necessity shall be
152152 122determined by the treating clinician in consultation with the patient and noted in the patient’s
153153 123medical record.
154154 124 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
155155 125renewed within the commonwealth, which is considered creditable coverage under section 1 of
156156 126chapter 111M, shall provide coverage for medically necessary mental health crisis stabilization
157157 127services for up to 14 days and shall not require preauthorization prior to obtaining such services;
158158 128provided, that the facility shall provide the carrier both notification of admission and the initial
159159 129treatment plan within 48 hours of admission; provided further, that utilization review procedures
160160 130may be initiated on day 7. Medical necessity shall be determined by the treating clinician in
161161 131consultation with the patient and noted in the patient’s medical record.
162162 132 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
163163 133renewed within the commonwealth, which is considered creditable coverage under section 1 of
164164 134chapter 111M, shall provide coverage for medically necessary community based acute treatment
165165 135services for up to 21 days; provided, that the facility shall provide the carrier both notification of
166166 136admission and the initial treatment plan within 48 hours of admission; provided further, that
167167 137utilization review procedures may be initiated on day 10. Medical necessity shall be determined
168168 138by the treating clinician in consultation with the patient and noted in the patient’s medical record. 8 of 14
169169 139 Any policy, contract, agreement, plan or certificate of insurance issued, delivered or
170170 140renewed within the commonwealth, which is considered creditable coverage under section 1 of
171171 141chapter 111M, shall provide coverage for medically necessary intensive community based acute
172172 142treatment services for up to 14 days; provided, that the facility shall provide the carrier both
173173 143notification of admission and the initial treatment plan within 48 hours of admission; provided
174174 144further, that utilization review procedures may be initiated on day 7. Medical necessity shall be
175175 145determined by the treating clinician in consultation with the patient and noted in the patient’s
176176 146medical record.
177177 147 SECTION 4. Chapter 176A of the General Laws is hereby amended by inserting after
178178 148section 8OO the following section:-
179179 149 Section 8PP. For the purposes of this section the following terms shall, unless the context
180180 150clearly requires otherwise, have the following meanings:
181181 151 “Mental health acute treatment”, 24-hour medically supervised mental health services
182182 152provided in an inpatient facility, licensed by the department of mental health, that provides
183183 153psychiatric evaluation, management, treatment and discharge planning in a structured treatment
184184 154milieu.
185185 155 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
186186 156diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
187187 157provided as an alternative to mental health acute treatment or following mental health acute
188188 158treatment, which may include intensive crisis stabilization counseling, outreach to families and
189189 159significant others and aftercare planning. 9 of 14
190190 160 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
191191 161diversionary or step-down services for children and adolescents, as defined by the department of
192192 162early education and care, usually provided as an alternative to mental health acute treatment.
193193 163 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
194194 164managed mental health diversionary or step-down services for children and adolescents, as
195195 165defined by the department of early education and care, usually provided as an alternative to
196196 166mental health acute treatment.
197197 167 Any contract between a subscriber and the corporation under an individual or group
198198 168hospital service plan which is delivered, issued or renewed within the commonwealth shall
199199 169provide coverage for medically necessary mental health acute treatment and shall not require a
200200 170preauthorization prior to obtaining treatment. Medical necessity shall be determined by the
201201 171treating clinician in consultation with the patient and noted in the patient’s medical record.
202202 172 Any contract between a subscriber and the corporation under an individual or group
203203 173hospital service plan which is delivered, issued or renewed within the commonwealth shall
204204 174provide coverage for medically necessary mental health crisis stabilization services for up to 14
205205 175days and shall not require preauthorization prior to obtaining such services; provided, that the
206206 176facility shall provide the carrier both notification of admission and the initial treatment plan
207207 177within 48 hours of admission; provided further, that utilization review procedures may be
208208 178initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
209209 179with the patient and noted in the patient’s medical record.
210210 180 Any contract between a subscriber and the corporation under an individual or group
211211 181hospital service plan which is delivered, issued or renewed within the commonwealth shall 10 of 14
212212 182provide coverage for medically necessary community based acute treatment services for up to 21
213213 183days; provided, that the facility shall provide the carrier both notification of admission and the
214214 184initial treatment plan within 48 hours of admission; provided further, that utilization review
215215 185procedures may be initiated on day 10. Medical necessity shall be determined by the treating
216216 186clinician in consultation with the patient and noted in the patient’s medical record.
217217 187 Any contract between a subscriber and the corporation under an individual or group
218218 188hospital service plan which is delivered, issued or renewed within the commonwealth shall
219219 189provide coverage for medically necessary intensive community based acute treatment services
220220 190for up to 14 days; provided, that the facility shall provide the carrier both notification of
221221 191admission and the initial treatment plan within 48 hours of admission; provided further, that
222222 192utilization review procedures may be initiated on day 7. Medical necessity shall be determined
223223 193by the treating clinician in consultation with the patient and noted in the patient’s medical record.
224224 194 SECTION 5. Chapter 176B of the General Laws is hereby amended by inserting after
225225 195section 4OO the following section:-
226226 196 Section 4PP. For the purposes of this section the following terms shall, unless the context
227227 197clearly requires otherwise, have the following meanings:
228228 198 “Mental health acute treatment”, 24-hour medically supervised mental health services
229229 199provided in an inpatient facility, licensed by the department of mental health, that provides
230230 200psychiatric evaluation, management, treatment and discharge planning in a structured treatment
231231 201milieu.
232232 202 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
233233 203diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually 11 of 14
234234 204provided as an alternative to mental health acute treatment or following mental health acute
235235 205treatment, which may include intensive crisis stabilization counseling, outreach to families and
236236 206significant others and aftercare planning.
237237 207 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
238238 208diversionary or step-down services for children and adolescents, as defined by the department of
239239 209early education and care, usually provided as an alternative to mental health acute treatment.
240240 210 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
241241 211managed mental health diversionary or step-down services for children and adolescents, as
242242 212defined by the department of early education and care, usually provided as an alternative to
243243 213mental health acute treatment.
244244 214 Any subscription certificate under an individual or group medical service agreement
245245 215delivered, issued or renewed within the commonwealth shall provide coverage for medically
246246 216necessary mental health acute treatment and shall not require a preauthorization prior to
247247 217obtaining treatment. Medical necessity shall be determined by the treating clinician in
248248 218consultation with the patient and noted in the patient’s medical record.
249249 219 Any subscription certificate under an individual or group medical service agreement
250250 220delivered, issued or renewed within the commonwealth shall provide coverage for medically
251251 221necessary mental health crisis stabilization services for up to 14 days and shall not require
252252 222preauthorization prior to obtaining such services; provided, that the facility shall provide the
253253 223carrier both notification of admission and the initial treatment plan within 48 hours of admission;
254254 224provided further, that utilization review procedures may be initiated on day 7. Medical necessity 12 of 14
255255 225shall be determined by the treating clinician in consultation with the patient and noted in the
256256 226patient’s medical record.
257257 227 Any subscription certificate under an individual or group medical service agreement
258258 228delivered, issued or renewed within the commonwealth shall provide coverage for medically
259259 229necessary community based acute treatment services for up to 21 days; provided, that the facility
260260 230shall provide the carrier both notification of admission and the initial treatment plan within 48
261261 231hours of admission; provided further, that utilization review procedures may be initiated on day
262262 23210. Medical necessity shall be determined by the treating clinician in consultation with the
263263 233patient and noted in the patient’s medical record.
264264 234 Any subscription certificate under an individual or group medical service agreement
265265 235delivered, issued or renewed within the commonwealth shall provide coverage for medically
266266 236necessary intensive community based acute treatment services for up to 14 days; provided, that
267267 237the facility shall provide the carrier both notification of admission and the initial treatment plan
268268 238within 48 hours of admission; provided further, that utilization review procedures may be
269269 239initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
270270 240with the patient and noted in the patient’s medical record.
271271 241 SECTION 6. Chapter 176G of the General Laws is hereby amended by inserting after
272272 242section 4GG the following section:-
273273 243 Section 4HH. For the purposes of this section the following terms shall, unless the
274274 244context clearly requires otherwise, have the following meanings:
275275 245 “Mental health acute treatment”, 24-hour medically supervised mental health services
276276 246provided in an inpatient facility, licensed by the department of mental health, that provides 13 of 14
277277 247psychiatric evaluation, management, treatment and discharge planning in a structured treatment
278278 248milieu.
279279 249 “Mental health crisis stabilization services”, 24-hour clinically managed mental health
280280 250diversionary or step-down services for adults or adolescents, as defined by MassHealth, usually
281281 251provided as an alternative to mental health acute treatment or following mental health acute
282282 252treatment, which may include intensive crisis stabilization counseling, outreach to families and
283283 253significant others and aftercare planning.
284284 254 “Community-based acute treatment (CBAT)”, 24-hour clinically managed mental health
285285 255diversionary or step-down services for children and adolescents, as defined by the department of
286286 256early education and care, usually provided as an alternative to mental health acute treatment.
287287 257 “Intensive community-based acute treatment (ICBAT)”, intensive 24-hour clinically
288288 258managed mental health diversionary or step-down services for children and adolescents, as
289289 259defined by the department of early education and care, usually provided as an alternative to
290290 260mental health acute treatment.
291291 261 Any individual or group health maintenance contract that is issued or renewed shall
292292 262provide coverage for medically necessary mental health acute treatment and shall not require a
293293 263preauthorization prior to obtaining treatment. Medical necessity shall be determined by the
294294 264treating clinician in consultation with the patient and noted in the patient’s medical record.
295295 265 Any individual or group health maintenance contract that is issued or renewed shall
296296 266provide coverage for medically necessary mental health crisis stabilization services for up to 14
297297 267days and shall not require preauthorization prior to obtaining such services; provided, that the
298298 268facility shall provide the carrier both notification of admission and the initial treatment plan 14 of 14
299299 269within 48 hours of admission; provided further, that utilization review procedures may be
300300 270initiated on day 7. Medical necessity shall be determined by the treating clinician in consultation
301301 271with the patient and noted in the patient’s medical record.
302302 272 Any individual or group health maintenance contract that is issued or renewed shall
303303 273provide coverage for medically necessary community based acute treatment services for up to 21
304304 274days; provided, that the facility shall provide the carrier both notification of admission and the
305305 275initial treatment plan within 48 hours of admission; provided further, that utilization review
306306 276procedures may be initiated on day 10. Medical necessity shall be determined by the treating
307307 277clinician in consultation with the patient and noted in the patient’s medical record.
308308 278 Any individual or group health maintenance contract that is issued or renewed shall
309309 279provide coverage for medically necessary intensive community based acute treatment services
310310 280for up to 14 days; provided, that the facility shall provide the carrier both notification of
311311 281admission and the initial treatment plan within 48 hours of admission; provided further, that
312312 282utilization review procedures may be initiated on day 7. Medical necessity shall be determined
313313 283by the treating clinician in consultation with the patient and noted in the patient’s medical record.